PURPOSE: To measure and analyze ocular deviations between dominant and non-dominant eyes using video-oculography (VOG) in intermittent exotropia. METHODS: Fourteen subjects who were diagnosed with intermittent exotropia from July 2017 to July 2018 with age of 5 or more, visual acuity of 20/30 or better and corrected visual acuity of 20/25 or more and difference in vision of both eyes of 1 line or less on Snellen optotype were included. The subjects were asked to fixate on a black-on-white optotype at 1 m, which subtended a visual angle of 50 minutes of arc. The video files and data about ocular deviations were obtained using VOG with alternate cover test. We analyzed angles of ocular deviations in dominant and non-dominant eyes. RESULTS: Among the 14 subjects in this study, the mean age were 7.6 ± 1.7 (range 5–9 years). Seven of 14 subjects had the right eye dominance. Six of the 14 subjects were men. There was no significant difference of ocular deviations between the dominant and non-dominant eyes in VOG (p = 0.167). Additionally, there was no significant difference of the values of VOG when one eye was exodeviated or re-fixated (p = 0.244), when both eyes were deviated, and when both eyes were re-fixated (p = 0.195, 0.637). CONCLUSIONS: In this study, there was no significant difference of ocular deviations between the dominant and non-dominant eyes, between when an eye was exodeviated or fixated using VOG. Therefore, it may not be a problem even if alternate prism cover test is performed in any eye in intermittent exotropia of more than 50 prism diopter without amblyopia or refraction abnormality that could affect the uncorrected visual acuity.
Amblyopia ; Dominance, Ocular ; Exotropia ; Humans ; Male ; Strabismus ; Visual Acuity

Purpose: To report a case of bilateral Descemet membrane detachment (DMD) persisting for over a month following phacoemulcification.Case summary: A 67-year-old female underwent bilateral phacoemulcification at a local clinic, with a 3-day interval between procedures on each eye. On the first postoperative day, both eyes developed DMD accompanied by central corneal edema. After 1 month of conservative treatment with no improvement, the patient was referred to our clinic. Upon presentation, corrected visual acuity was 0.25 in the right eye and 0.2 in the left eye. The right eye was initially treated with a 0.3-mL injection of 10% sulfur hexafluoride (SF6), which did not result in reattachment. However, reattachment was successfully achieved with a subsequent injection of 20% SF6. In the left eye, a 20% SF6 injection into the anterior chamber also achieved reattachment, but partial removal of 10-20% of the gas was necessary to manage elevated intraocular pressure. The procedure was completed without complications. Following treatment, visual acuity improved to 0.8 in the right eye and 1.0 in the left eye. Conclusions For cases of DMD involving the central cornea or persisting for over 4 weeks without responding to conservative treatment, the injection of 20% SF6 gas into the anterior chamber represents a viable surgical option. Careful management of intraocular pressure is essential to ensure successful outcomes without complications.

Purpose: To report a case of bilateral Descemet membrane detachment (DMD) persisting for over a month following phacoemulcification.Case summary: A 67-year-old female underwent bilateral phacoemulcification at a local clinic, with a 3-day interval between procedures on each eye. On the first postoperative day, both eyes developed DMD accompanied by central corneal edema. After 1 month of conservative treatment with no improvement, the patient was referred to our clinic. Upon presentation, corrected visual acuity was 0.25 in the right eye and 0.2 in the left eye. The right eye was initially treated with a 0.3-mL injection of 10% sulfur hexafluoride (SF6), which did not result in reattachment. However, reattachment was successfully achieved with a subsequent injection of 20% SF6. In the left eye, a 20% SF6 injection into the anterior chamber also achieved reattachment, but partial removal of 10-20% of the gas was necessary to manage elevated intraocular pressure. The procedure was completed without complications. Following treatment, visual acuity improved to 0.8 in the right eye and 1.0 in the left eye. Conclusions For cases of DMD involving the central cornea or persisting for over 4 weeks without responding to conservative treatment, the injection of 20% SF6 gas into the anterior chamber represents a viable surgical option. Careful management of intraocular pressure is essential to ensure successful outcomes without complications.

Purpose: To report a case of bilateral Descemet membrane detachment (DMD) persisting for over a month following phacoemulcification.Case summary: A 67-year-old female underwent bilateral phacoemulcification at a local clinic, with a 3-day interval between procedures on each eye. On the first postoperative day, both eyes developed DMD accompanied by central corneal edema. After 1 month of conservative treatment with no improvement, the patient was referred to our clinic. Upon presentation, corrected visual acuity was 0.25 in the right eye and 0.2 in the left eye. The right eye was initially treated with a 0.3-mL injection of 10% sulfur hexafluoride (SF6), which did not result in reattachment. However, reattachment was successfully achieved with a subsequent injection of 20% SF6. In the left eye, a 20% SF6 injection into the anterior chamber also achieved reattachment, but partial removal of 10-20% of the gas was necessary to manage elevated intraocular pressure. The procedure was completed without complications. Following treatment, visual acuity improved to 0.8 in the right eye and 1.0 in the left eye. Conclusions For cases of DMD involving the central cornea or persisting for over 4 weeks without responding to conservative treatment, the injection of 20% SF6 gas into the anterior chamber represents a viable surgical option. Careful management of intraocular pressure is essential to ensure successful outcomes without complications.

We reported a case of a 55-year-old patient who presented with palpitation after swallowing. Initial surface electrocardiogram revealed ventricular preexcitation utilizing a left lateral bypass tract. The orthodromic atrioventricular reentrant tachycardia (AVRT) was induced during electrophysiologic studies. After successful ablation of the AVRT utilizing a left lateral free wall bypass tract, 2 different atrial tachycardias (ATs) were induced under isoproterenol infusion. When the patient swallowed saliva or drank water, 2 consecutive beats of atrial premature complexes (APCs) preceded another non-sustained AT repeatedly, which was coincident with the patient's symptom. The preceding APC couplet had the same activation sequence with one induced AT, and the subsequent non-sustained AT had the same activation sequence with the other induced AT, respectively. We first targeted the preceding 2 consecutive APCs at the left posterior interatrial septum. The following non-sustained AT was also eliminated following ablation of the APCs. After ablation, the patient remained free from the swallowing-induced atrial tachyarrhythmias during the one year follow-up.
Atrial Premature Complexes ; Catheter Ablation ; Deglutition ; Electrocardiography ; Follow-Up Studies ; Humans ; Isoproterenol ; Middle Aged ; Saliva ; Tachycardia* ; Water ; Wolff-Parkinson-White Syndrome*

BACKGROUND: Clonidine has been regarded as an adequate supplementary anesthetic during epidural anesthesia and has been used with local anesthetics such as bupivacaine or lidocaine to support the effects of these anesthetics. The authors would examine whether clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia. METHODS: Thirty-two healthy patients undergoing a hip or lower limb surgery were divided into two groups. In group 1, 0.5% ropivacaine 15 ml was administered. In group 2, 0.5% ropivacaine 15 ml combined with clonidine 150 micro gram was administered. Onset, duration and maximal height of sensory block were assessed. Sedation score, blood pressure and heart rate were measured. RESULTS: Duration of sensory block of group 2 was significantly longer than that of group 1. Sedation score of group 2 was significantly higher than that of group 1. Blood pressure of group 2 was significantly lower than that of group 1 at 50 min, 70 min and 90 min after epidural injection. No significant differences were observed in onset of sensory block and heart rate between the two groups. CONCLUSIONS: The addition of clonidine to ropivacaine during epidural anesthesia prolonged duration of sensory block and produced useful sedation. It caused relatively stable hemodynamic changes. These results suggest that clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia.
Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local ; Blood Pressure ; Bupivacaine ; Clonidine* ; Heart Rate ; Hemodynamics ; Hip ; Humans ; Injections, Epidural ; Lidocaine ; Lower Extremity ; Sympathetic Nervous System

BACKGROUND: Although spinal anesthesia has a lot of advantages, it has some disadvantages or undesirable effects. Hypotension and unnecessarily long neural blockade are included among them. Although using small dose local anesthetics fairly solves these problems, it is insufficient to provide reliable surgical anesthesia by itself. Therefore the authors investigated whether such an opioid as fentanyl and a small dose local anesthetic used together during spinal anesthesia can prevent hypotension and unnecessarily long neural blockade and provide reliable surgical anesthesia simultaneously. METHODS: Thirty patients undergoing knee or below knee surgery were randomized into two groups. Group 1 received bupivacaine 5 mg combined with fentanyl 20 micro gram, and group 2 received 10 mg bupivacaine. Hypotension was recorded and was treated with intravenous ephedrine. Sensory blockade, intraoperative analgesia, motor blockade and side effects were assessed. RESULTS: No significant differences were observed in values for assessing hypotension, sensory blockade or intraoperative analgesia between the two groups. Also no significant differences were observed in intensity of the motor blockade and side effects between the two groups. However the duration of the motor blockade of group 1 was longer significantly than that of group 2. CONCLUSIONS: Small dose bupivacaine and fentanyl administered together intrathecally reduced duration of motor blockade and didn't augment of side effects and provided reliable anesthesia for surgery of knee or below knee simultaneously.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine* ; Ephedrine ; Fentanyl ; Humans ; Hypotension ; Knee

BACKGROUND: Clonidine has been regarded as an adequate supplementary anesthetic during epidural anesthesia and has been used with local anesthetics such as bupivacaine or lidocaine to support the effects of these anesthetics. The authors would examine whether clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia. METHODS: Thirty-two healthy patients undergoing a hip or lower limb surgery were divided into two groups. In group 1, 0.5% ropivacaine 15 ml was administered. In group 2, 0.5% ropivacaine 15 ml combined with clonidine 150 micro gram was administered. Onset, duration and maximal height of sensory block were assessed. Sedation score, blood pressure and heart rate were measured. RESULTS: Duration of sensory block of group 2 was significantly longer than that of group 1. Sedation score of group 2 was significantly higher than that of group 1. Blood pressure of group 2 was significantly lower than that of group 1 at 50 min, 70 min and 90 min after epidural injection. No significant differences were observed in onset of sensory block and heart rate between the two groups. CONCLUSIONS: The addition of clonidine to ropivacaine during epidural anesthesia prolonged duration of sensory block and produced useful sedation. It caused relatively stable hemodynamic changes. These results suggest that clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia.
Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local ; Blood Pressure ; Bupivacaine ; Clonidine* ; Heart Rate ; Hemodynamics ; Hip ; Humans ; Injections, Epidural ; Lidocaine ; Lower Extremity ; Sympathetic Nervous System

BACKGROUND: Although spinal anesthesia has a lot of advantages, it has some disadvantages or undesirable effects. Hypotension and unnecessarily long neural blockade are included among them. Although using small dose local anesthetics fairly solves these problems, it is insufficient to provide reliable surgical anesthesia by itself. Therefore the authors investigated whether such an opioid as fentanyl and a small dose local anesthetic used together during spinal anesthesia can prevent hypotension and unnecessarily long neural blockade and provide reliable surgical anesthesia simultaneously. METHODS: Thirty patients undergoing knee or below knee surgery were randomized into two groups. Group 1 received bupivacaine 5 mg combined with fentanyl 20 micro gram, and group 2 received 10 mg bupivacaine. Hypotension was recorded and was treated with intravenous ephedrine. Sensory blockade, intraoperative analgesia, motor blockade and side effects were assessed. RESULTS: No significant differences were observed in values for assessing hypotension, sensory blockade or intraoperative analgesia between the two groups. Also no significant differences were observed in intensity of the motor blockade and side effects between the two groups. However the duration of the motor blockade of group 1 was longer significantly than that of group 2. CONCLUSIONS: Small dose bupivacaine and fentanyl administered together intrathecally reduced duration of motor blockade and didn't augment of side effects and provided reliable anesthesia for surgery of knee or below knee simultaneously.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine* ; Ephedrine ; Fentanyl ; Humans ; Hypotension ; Knee

We report a unique case of a neonate with an epidural hematoma induced by vacuum extraction. The epidural hematoma, communicating with a cephalhematoma through a linear skull fracture, disappeared after ultrasound-guided needle aspiration. The patient quickly recovered and one month later computed tomography revealed a complete resolution of the epidural hematoma.
Hematoma ; Hematoma, Epidural, Cranial* ; Humans ; Infant, Newborn* ; Needles* ; Skull Fractures ; Vacuum